Tennis Elbow - we hear a lot about it and almost everyone that comes in with elbow pain has researched it.
But - what is it? Essentially, it is an overuse injury that causes strain to the muscles that extend the wrist. As with most overuse injuries, the load applied to the area exceeds the capacity of the tendon and muscle to deal with the load. The tendon then undergoes a series of changes and pain can develop.
From this - we can see that there are two ways to manage this - we can either reduce load and/or increase capacity. If we reduce load too much (rest completely) - the tendon weakens further and causes ongoing issues. If we increase capacity - then the tendon gets stronger and can better deal with the load.
Here is what the evidence says when it comes to treating Tennis Elbow:
Wegener et al. 2016 - A randomized controlled trial of comparative effectiveness of elastic therapeutic tape, sham tape or eccentric exercises alone for lateral elbow tendinosis
The interventions were: elastic therapeutic tape and eccentric exercises vs sham tape and eccentric exercises vs eccentric exercises alone
- All groups had education on activity modification techniques.
- 12-week duration: 1 per week treatment over 4 weeks, then 4 sessions per fortnight
- outcome measures were recorded at baseline, three months and six months
- At 3 months, all groups improved in the Patient-Rated Tennis Elbow Evaluation, the Short Form 36, pain-free grip strength, and the Occupational Self-Assessment
- All groups improved - the common link was exercise and so this is an imperative component of any treatment program.
Peterson et al. (2011) - A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis) elastic therapeutic tape and eccentric exercises
The interventions were: education on condition being harmless AND 3-month daily exercise regime performed at home, with progressively increasing load on the extensor muscles vs Control: ‘wait and see’, education on condition being harmless
- The exercise group had greater and faster regression of pain, both during muscle contraction and muscle elongation, than the control
Struijs et al. 2004 - Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial
The interventions were: effectiveness of brace-only treatment, physical therapy, and the combination of these for patients with tennis elbow
- Physical therapy was superior to brace only at 6 weeks for pain, disability, and satisfaction
- Brace-only treatment was superior on ability of daily activities
- Combination treatment was superior to brace on severity of complaints, disability, and satisfaction
Take home messages
- Exercise reduces elbow pain, improves function and strength
- Exercise has a greater and faster regression of pain
- Effective dosage is between 2-3x per week over a 6-12 week period
- Combination of elbow brace and exercise therapy reduces pain and improves function in the short and long term